I’m Worried about My Child’s Speech, Should I Be?

When talking with parents/caregivers to determine if an assessment is indicated there are several deciding factors taken into account. Some of these factors include, of course, what the child’s expressive (output) and receptive (comprehension) language is like. However, as important to consider are frustration, medical diagnosis, second or third languages, child’ personality, etc.

One of the very things I caution parents about is comparison to peers and friend’s children. Also, there is such a wide range of what is typical development and with late night internet searches it is easy to get misinformation.

For the 18-24 month old child:

In my experience, it’s around this time parents might start to wonder if their child is delayed. I hear over and over pediatricians offer advice such as “wait”, “he’s a boy”, “he’s the youngest”. While some of this information should be taken into account during an assessment it’s not the answer. One of the most important things to watch for during this time is change and progress.

For the young children we often look at communicative intent, is the child trying to communicate in some way. Is she pulling you, pointing, gesturing, shaking her head? Those are all examples of communication.

By 18-24 months, your child should use between 20-50 words consistently.  She might be combining two words together. Importantly, you child should be imitating words and actions.

She can usually identify more words than she can say. “NO” might be a favorite word and she can follow simple, routine directions.

Her speech will likely be a combination of unintelligible and clear words. Sounds that we expect for this age include: p,b,m,n,d,t,w,h. Speech at this age is often characterized by dropping the final consonant or weak syllable in the word.

For the two year old:

At this age it’s not easy to tell. There is a such a wide range of normal.

Just be sure your child’s speech is improving over time — by age 3 most of what your child says should be pretty understandable. However, if your child is talking very little, you should act more quickly. Rule out a hearing problem first.

See a speech-language pathologist if your child is doing any of the following:

• Not reacting normally or consistently to sounds (she may be overly sensitive to sounds such as vacuums or hair dryers yet seems indifferent when people call her name)
• Mispronouncing vowels, saying “coo” instead of “cow”
• Talking using mostly vowels, omitting whole consonants, saying “a” for “cat”
• Using one catch-all sound or syllable to name most things (duh or duh-duh is a common one)
• Using a word once and then not using it again
• Not pointing to objects in books (if you say, “Show me the kitty cat,” she flips the page or repeats the phrase but doesn’t point to the animal)
• Not seeming frustrated when you don’t know what she wants (she may simply try to get the object herself or just give up very easily)
• Answering a question by repeating part of your question. If you say, “Do you want milk?” she responds by saying, “…you want milk?” instead of nodding her head or saying yes (this is called echolalia, and may be an early sign of autism)
• Not saying “bye-bye” or reacting to games such as peekaboo
• Still saying single words only, and not phrases or sentences
• Not changing or developing her language much from month to month

For the preschooler:

Preschoolers continue to have difficulty with pronunciation.  Just be sure your preschooler’s speech is improving over time.  A general rule is that by age 3 your child should be 75% intelligible to unfamiliar listeners and by age four 90% intelligible.  Some tip-offs that she may not outgrow her pronunciation problems include drooling when she mispronounces words or difficulty eating or swallowing. In such cases, there may be a physical component to your preschooler’s difficulties, and she may need professional help.

However, if your child isn’t talking or is talking very little, you should act more quickly. Rule out a hearing problem first.

See a speech-language pathologist if your child is doing any of the following:

• Mispronouncing vowels, saying “coo” instead of “cow”
• Talking using mostly vowels, omitting whole consonants, saying “a” for “cat”
• Still saying single words only, and not phrases or sentences
• Using a limited vocabulary. Or saying a word once and then not using it again
• Not pointing to objects in books. If you say, “Show me the kitty cat,” he flips the page or repeats the phrase but doesn’t actually point to the animal
• Answering a question by repeating part of your question. If you say, “Do you want milk?” he responds by saying, “…you want milk?” instead of nodding his head or saying yes (this is called echolalia, and may be an early sign of autism)
• Not following simple directions and understanding prepositions such as under, on, or over. For instance, he doesn’t turn around when you say, “Your ball is right behind you”
• Struggling using pronouns, saying, “Him not here”
• Confusing gender, saying, “He hit me” when he’s talking about his sister
• Not changing or developing his language much from month to month

Age-appropriate sound errors for a 2, 3, 4 year old:

• “f” pronounced as “p,” such as “pish” instead of “fish”
• “g” pronounced as “d,” such as “dame” instead of “game”
• “ch” pronounced as a “sh,” such as “wash” instead of “watch”
• “sh” pronounced as a “s,” such as “sip” instead of “ship”
• consonants in the middle of words left out, so “baseball” becomes “bayball”
• words with more than one syllable become shortened or simplified, so “Emily” becomes “Memmy” or “Emmy”
• “l” pronounced as a “w” or a “y,” such as “yeg” instead of “leg”
• “r” pronounced as a “w,” such as “wabbit” instead of “rabbit”
• “s” often lisped as a “th” sound, such as “thun” instead of “sun”
• “v” pronounced as a “b,” such as “ban” instead of “van”
• f or d sound for th
• consonant blends, where two consonants are right next to each other, such as bl, dr, th, tr, dr, sl, sm, sn, and st, mispronounced by leaving one of the sounds off (“stop” becomes “top” or “sop”)
• leaving off the ends of words “bu” for “bus” (until age three)
• dropping syllables within words “puter” for “computer” (until age three)

Jennifer Katz has worked in the field of communication disorders for over 15 years. Jennifer is part of a city-wide transdisciplinary team working to bring inclusion to preschools in San Francisco. In addition, she is a board member for the Autism Social Connection and Community Alliance for Special Education, and she is a founding Advisory Board Member for Gooseling, Inc. She has also served as an adjunct supervisor and lecturer at San Francisco State University. Jennifer’s web site is http://www.katzspeech.com.